Small Animal Laparoscopy and Thoracoscopy. Группа авторов

Monitors, Auxiliary Screens, and “All‐in‐One” Video Systems

To achieve superior live images during surgery, the quality of the display monitors and auxiliary screens is as important as any other aspect of the video chain. They vary in size, resolution, inputs, and other features. Monitors 17–26 in. are the most common. Flat screen monitors have replaced the old CRT monitors, as in consumer electronics. The resolution of the monitor should match or surpass the resolution of the other elements of the imaging chain. Surgical display monitors should have a minimum of 500 lines for standard definition single‐chip cameras, 750 lines for standard definition three‐chip cameras, and 1080p to obtain maximum benefit from a full HD camera system [1–5].

Figure 3.9 (A). 4K modular imaging system combining white light and NIR/ICG applications. IMAGE 1 S Connect II and IMAGE 1 S 4U Linc modules. (B). FULL HD 1920 × 1080 all‐in‐one unit consisting of a camera control unit, LED light source, 18.5 in. touch screen (16 : 9 format), digital capture system.

      Source: TELEPACK + © KARL STORZ SE & Co. KG, Germany.

Figure 3.10 Insufflators. (A). Veterinary dedicated insufflator with max flow of 20 l/min. (B). State‐of‐the‐art electronic insufflator combined with heating system and a max flow of 50 l/min.

      Source: © KARL STORZ SE & Co. KG, Germany

      A 4K Image is best displayed on a monitor of 32 in. or more, as smaller monitors do not have the capability of showing the detail generated by a 4K camera.

      Ideally, multiple mobile monitors should be situated opposite the surgeon and surgeon's assistants so that each surgical team member has a straightforward view [9,44–48]. Modern FULL HD Compact “all‐in‐one” units typically include a CCU, light source, 18.5 in. monitor, insufflation pump (for flexible endoscopy), screen, and image capture module (Figure 3.9b). These units can provide a FULL HD image connected to rigid endoscopes, traditional and CMOS flexible endoscopes, and newer disposable flexible endoscopes. A dedicated keyboard can be attached, allowing the surgical team to enter patient data, and send it to a hospital network via USB cable or flash drives. These state‐of‐the‐art units also comprise DVI external outputs for the connection of multiple auxiliary monitors [1–5, 8, 13, 14].

      Insufflators

      A CO₂ insufflator is used to create and maintain a working space between the telescope and the target tissues [49, 50]. The insufflator automatically controls CO₂ flow rate and pressure throughout the procedure.

      The carbon dioxide source is typically a pressurized tank connected to the insufflator with a high‐pressure hose. However, in referral facilities an in‐house gas delivery system may be available. The reduced pressure CO₂ gas is delivered to the patient via sterilized tubing that connects from the front panel of the insufflator to the hub of a Veress needle or Luer‐lock connector on a cannula.

      An antibacterial sterile filter should be coupled in between the patient insufflation tube and the unit, which prevents contamination from the CO₂ tank to the patient or from the patient to the insufflator. The filter also will prevent the entrance of fluid back into the unit thus avoiding permanent damage [1–5, 8,49–51].

Standard veterinary insufflators feature a maximum flow of 20 l/min, since for small animal MIS, it is rarely suggested to use a flow over 2.5 l/min (Figure 3.10a). Nevertheless, advanced models of 40 and 50 l/min are also available, and feature OR integration abilities, thus making possible to control all units from one single station platform. Electronic insufflators with gas heating are available to minimize hypothermia, and generally comprise 50 l/min high flow. (Figure 3.10b) [9].

Capture and Storage of Images and Video

      Over the past decade, digital image capturing systems have effectively made SLR cameras, video cassette recorders (VCRs), and video printers obsolete. When trying to capture images directly to a computer, most practitioners face some limitations directly related to the outputs on the CCU and monitor and the inputs of the computer itself. Software compatibility may also be an issue. The ultimate image quality and user friendliness are critical factors [1–5, 13].

Newer sophisticated digital capture systems (Figure 3.11) offer 4K and FULL HD 3‐D image quality and easy export of data to the hospital network or patient files. Most units also have an internal storage of limited volume, including patient‐related information. Still images and videos are captured and stored on the unit's hard drive or alternatively recorded onto USB flash drives, CD‐ROM/DVD, or external devices.

Figure 3.11 Digital capture and archiving system with integrated touch screen. Modern units allow recording FULL HD, 3D, and 4K signals.

      Source: © KARL STORZ SE & Co. KG, Germany.

      Some endoscopic camera systems contain an integrated capture system (Figures 3.9b). These integrated systems lack some of the features of independent image capture and archiving systems [1–5]. However, they are useful for simple documentation when more sophisticated digital capture systems are not available.

Video Carts and Ceiling Booms

Mobile equipment carts (Figure 3.12) are essential for MIS. A multi‐shelf wheeled cart is a common choice, which contains multiple electrical outlets for the equipment and insulated wheels which fulfill the electrical safety standards for medical equipment. The cart may also accommodate peripheral arms or stands for auxiliary screens and other devices (e.g., touch screen for digital capture or integrated software platforms) and drawers to store accessory instrumentation such as cables, filters, tubing, etc. [1–5, 8]

      New hardware and design concepts help organize the OR, keeping flooring free from cables and easing cleaning and sterilization. Ceiling‐mounted movable arms or tracks can conveniently position equipment near the patient while freeing the floor space around the operating table. Ceiling booms can be fixed or movable by means of suspended racks and are highly advantageous in the OR. They provide integrated electrical connection as well as access to gas lines and suction (“air‐pods”), and they provide shelves and drawers. Other less complex ceiling booms support surgical illumination and auxiliary screens, which are standard in modern MIS suites. Disadvantages mainly include cost and specific installation requirements.